Brazil

Brazil has the 9th largest economy in the world, with a GDP of USD 1.86 trillion, of which USD 160 billion represents the health sector. The Brazilian government operates the largest universal health care systems to date, providing free services to over 210 million people through the Sistema Único de Saúde (SUS). It also has the world’s second-largest private health sector, which includes some of the world’s best-performing hospital groups.

Furthermore, Brazil is the leading medical device market in Latin America and the second-largest pharmaceutical market in the world. The Brazilian economy has been struggling over the past years and more recently, was hit very hard by the COVID-19 pandemic. As healthcare demands are growing and resources in the public sector become scarcer, Brazil’s health system is transforming to become future-proof, in which digitalization plays a central role.. This transformation leads to opportunities for Dutch healthcare solutions in areas such as health information management systems, telemedicine and high-tech equipment for which Brazil depends on imports. The large industries and excellent science, technology and innovation climate in Brazil also provide opportunities for the Dutch sector related to STI cooperation and investments.

Additionally, Brazil is a crucial partner in Global Health, a country where the challenges of climate change, biodiversity, human development and health(care) all come together in One Health. It is a global leader in combatting infectious and tropical diseases and notwithstanding the dismal response of the previous federal government to the COVID-19 pandemic, Brazil has a longer standing reputation to respond adequately to infectious disease outbreaks thanks to a well-organized data infrastructure, a strong scientific base and home-based vaccine and medication production. In recent years biotechnology and (bio)pharmaceutical innovation is on the rise, which combined with its leadership in combatting infectious and tropical disease, makes it interesting for innovative biotechnology companies.

Brazil

From the perspective of the Netherlands, the following market trends (more information, see below) in Brazil are of interest: 

Trade

Brazil’s major transformations in its health sector provide numerous trade and innovate opportunities for the Dutch LSH sector:

1.     Public health

2.     One Health

3.     Digital transformation of the health system

4.     Healthy Ageing and well-being
 

Specific regional priorities

State of Minas Gerais (NBSO Belo Horizonte)

Minas Gerais hosts the first industrial airport in Brazil, having LSH as one of its priority areas. Companies will have several benefits and tax advantages to produce goods for export in Latin American market. Also, in the Airport region, a Medical City is being built to concentrate all the components that make up the “Health Productive Chain of the XXI Century”

Southern Brazil (NBSO Porto Alegre)

There are three Innovation Centres in South Brazil: health-tech ecosystem and brain research institute at Biohub PUCRS; the Atrion collaboration incubator at Hospital Moinhos de Vento HMV, 2nd best hospital in Brazil in 2021. The office subscribed a support letter with HMV for further collaboration with Dutch companies and institutions. University Medical Center Groningen signed an international partnership with the universities PUCRS and UFRGS.
 

Science, Technology and Innovation diplomacy

Although federal investments in education, science, technology and innovation are under pressure in recent years, Brazil is still the most important country in Latin America in the field of science, technology and innovation. In particular, the state of São Paulo, as the largest innovation ecosystem in Latin America, also due to the fact that STI investments at the state-level are stable. 

Since the Brazilian and Dutch government signed a MoU on Science, Technology and Inovation (STI) cooperation in 2011, many bilateral (bottom-up) contacts have been established and consortia built for calls for proposals. These include highly knowledge intensive companies, universities, Dutch university medical hospitals, tech institutes and government related organisations. Priority areas for NL-BR collaboration include healthy ageing, digitalisation of health system, use of big data, artificial intelligence, MedTech, FAIR data, advanced materials, diagnostics (kits), lifestyle & prevention (research and applications), infectious diseases, community & home care, gamification, bioinformatics, personalised and precision care.

The Joint Program of Cooperation between the Netherlands and Brazil on Science, Technology and Innovation (2020-2023) was signed end of 2019. This program intends to facilitate the further exchange of expertise and knowledge through events, visits, workshops and joint calls. Life Sciences and Health is one of the priority areas. In 2022, within the framework of the program of cooperation, several LSH related activities have taken place, such as an innovation mission on the topic of advanced materials for health, linked to the NWO-FAPESP research call on Advanced Healthcare Materials, and a Eureka Global Stars call resulting in three Dutch-Brazilian innovation projects between companies in LSH.

Overview of Dutch interest in Brazil per organization type (based on International research, Achilles):

During a survey by the Dutch LSH alliance in 2019, 63 unique organizations with activity and/or interest in Brazil were identified (total of 81 respondents). The majority of organizations with activity or interest in Brazil include digital health companies (19), followed by healthcare equipment companies (18), public health & knowledge (10) and hospital construction (8).  

In 2018-2019, Achilles registered 160 requests from LSH companies who actively looked for support from the Dutch government with doing business in Brazil.
 

Most prominent NL value chains

1.     The Digital Transformation of Health and Care

  • Potential opportunities: In 2020, the Brazilian Ministry of Health launched the Brazilian National Digital Health strategy which prioritises digital transformation through DATASUS and the public and private sector are investing in HIMMS, EMRs and interoperability between hospitals and healthcare insurers. During the pandemic consolidation in hospital groups has started. Brazil has an enormous amount of hospitals and consolidation will make the landscape somewhat more clear. Furthermore, multiple, large-scale telemedicine initiatives have been deployed and are developing further. Lastly, Brazil needs human capital to implement and manage its growing electronic health infrastructure.
  • Barriers: Dutch companies encounter difficulties in managing their business in Brazil due to the distance, language barriers and long development time of projects. Due to the pandemic, many Dutch Digital Health-solutions are focusing more on the European market.

2.     Accessible Medical Technology for Sustainable Health and Care

  • Potential opportunities: Brazil is the leading medical device market in Latin America and houses a huge market. It is mainly private providers who seek to remain competitive and who are investing in their technology.
  • Barriers: Regulatory affairs in Brazil are perceived as stricter compared to other Latin American countries. Many Dutch organisations experience Brazil’s ANVISA as bureaucratic and time-consuming. Furthermore, Brazil’s large developed LSH industry makes for a competitive local market. Dutch red ocean products therefore experience lower success rates on the Brazilian market. Solutions in higher price ranges might experience difficulty when entering Brazil’s public sector market, because it is heavily focusing on low price in order to service the poorer part of the population.

3.     Public Health

  • Potential opportunities: Training & education of Brazil’s workforce. Implementation of new models in nursing and long-term care, for example.
  • Barriers: One of the biggest barriers encountered by Dutch organisations is related to difficulties in turning leads into projects. If the benefits of implementing new technologies and models are not apparent to Brazilian stakeholders, then they do not tend to see these as a priority.

 

Overview milestones & flagships

  • G2G (MoU STI, state and governmental visits)
  • Trade (PIBs, market studies)
  • Science, Technology & Innovation (G2G MoU on STI 2011, G2G Programme of Cooperation STI 2020-2023, including LSH, joint R&D projects financed by FAPESP-NOW bilateral calls on health, 2011-2021 bilateral collaboration agreements, calls for proposals NL-BR, e.g. via Eureka Global Stars.
  • Invest (significant investments in the Dutch LSH sector)


Collective Trade and STI activities

2015

  • Fact finding mission Task Force Health Care (TFHC) to Brazil (IA Brazil), including a roundtable discussion with Brazilian health leaders 

2016

  • Mission (lead by IA Brazil and NFIA) of Brazilian health leaders to the Netherlands
  • Dutch Research Council (NWO)-FAPESP call for proposal ‘Data-driven research on Sports & healthy living’; 3 joint NL-BR projects

2017

  • Dutch high-level participation at AMR conference EU- South America in Brazil
  • Dutch speakers at HiMSS@Hospitalar/Healthcare Information and Management Systems Society (e.g. health/ lifestyle applications, gamification, bioinformatics, personalised and precision care, healthy ageing)
  • Economic Mission leads by Ministry of Health, Welfare and Sport (VWS) and Innovation Attache (IA), including the Netherlands as host country at Hospitalar, NL pavilion, publications, matchmaking, etc.

2018

  • Brazilian high-level delegation World of Health Care Netherlands
  • Dutch speakers at HiMSS@Hospitalar/Healthcare Information and Management Systems Society (e.g. health/ lifestyle applications, gamification, bioinformatics, personalised and precision care, healthy ageing)
  • Visit of health care delegation from Rio Grande do Sul to University of Twente
  • Publication IoT and Networking Technology in Brazil, opportunities in Health (IA Brazil)
  • Innovation visit of State Secretary, Mona Keijzer, Ministry of Economic Affairs and Climate Policy (EZK) to São Paulo; meeting with, among others, board of the Einstein hospital 

2019

  • Netherlands Enterprise Agency (RVO) TFHC Market Study LSH
  • Seminar in which opportunities, identified in the Market Study, were presented
  • Brazilian high-level delegation World of Health Care Netherlands
  • Dutch speakers at HiMSS@Hospitalar/Healthcare Information and Management Systems Society (e.g. health/ lifestyle applications, gamification, bioinformatics,personalised and precision care, healthy ageing)
  • Pitches Dutch high-tech companies at Einstein private hospital
  • Netherlands Round Table with Dutch speakers at CISS/Congress of health services
  • Matchmaking event organised at Hospitalar by Netherlands Business Support Office Porto Alegre with companies from Rio Grande do Sul
  • NWO-FAPESP joint Call for Proposals’ Healthy Ageing’; 4 joint NL-BR projects
  • Innovation mission Big data in Health lead by IA, EZK and RVO: São Paulo, Porto Alegre and Rio de Janeiro
  • Dutch pavilion at CONAHP, with Dutch keynote speaker Ernst Kuipers, Erasmus MC
  • Signing of G2G Programme of Cooperation on STI 2020-2023, including LSH. Partners: the Brazilian Ministry of Science, Technology and Innovation and the Dutch Ministry of EZK and Ministry of Education, Culture and Science (OCW). 

2020

  • Brazilian high-level delegation (digital) World of Health Care Netherlands
  • NBSO Market Study Minas Gerais
  • Buurtzorg signs strategic collaboration agreement with Brazilian organisation Laços Saúde
  • IA Brazil policy Intelligence for Dutch Ministries related to the COVID19 pandemic and Economic & Knowledge Security
  • Partnership Spectator and Elsevier on Telehealth solutions in Brazil

2021

  • IA Brazil policy Intelligence for Dutch Ministries related to the COVID19 pandemic and Economic and Knowledge Security
  • IA Brazil ‘Artificial Intelligence in Health special Brazil
  • Cooperation between NBSO Porto Alegre and Hospital Moinhos de Vento
  • LATAM Business Dialogue
  • H~H Digital Meet-up

2022

  • Innovation mission ‘Advanced Materials in Healthcare’ to São Paulo
  • NWO-FAPESP research call on Advanced Health Materials (outcome in 2023)
  • RVO-EMBRAPII GlobalStars call, resulted in 3 business driven MedTech R&D&I projects
  • JAIN (Joint Artificial Intelligence Network) established relationship with Brazilian Alzheimer Federation, Laços Saude and knowledge institutes to set up fieldlab to bring technology solutions for people with memory loss to Brazil (kick-off in 2023).
  • H~H Digital Meet-up LATAM

The way forward

Brazil is a market which in the past exerted a high attraction on the Dutch LSH sector due to its size and interesting developments. After some large-scale activities, a selection of Dutch organisations with strong propositions continues to grow their engagement with the market while the larger group of more explorative companies shows a decreasing interest due to barriers posed in the Brazilian market.

From the science & innovation perspective and with the Joint Program of Cooperation 2020-2023 as guideline, Brazil continues to be a priority country for the Ministry of Economic Affairs, Ministry Education, Culture and Science, NWO, and RVO, leading to a high potential for international collaborations. In advance to the next joint committee meeting, the continuation and future content of the program of cooperation after 2023 will be discussed.

Due to the economic recession and subsequent pandemic in Brazil, many Dutch organisations have disengaged from the Brazilian market. Therefore, the public-private partnership to grow the mutual value between the Brazilian and Dutch LSH-market aims to continue support to acting and successful Dutch organisations on the Brazilian market and rekindle interest from Dutch organisations to explore the Brazilian market post the COVID-19 pandemic. The following activities will therefore be organised:

Inform Dutch LSH sector on market opportunities in Brazil:

  • Marketing & Communication: showcasing Dutch-Brazilian success stories through articles, videos and by inviting Dutch companies at events so they can share success stories
  • Seek focused cooperation and opportunities with local health care clusters in the locations where Dutch economic network is present, including start-ups/incubators: Sao Paulo, Rio de Janeiro, Belo Horizonte and Porto Alegre in the southern state of Rio Grande do Sul  

Intensive guidance/soft-landing of individual organisations in the Brazilian market:

  • Ad hoc guidance
  • Reactive support
  • Ad hoc assistance to interested Dutch organisations
  • Pro-active matching of Dutch companies with business partners
  • Positioning individual companies at congresses

Collective support: if a group of organisations emerges, we will look to explore larger-scale activities:

  • Collective activities
  • Explore thematic dialogues

Ambition:

  • Economic Mission in 2023 or 2024
  • Continued assistance of bilateral contacts, e.g. in the area of healthy ageing, such as supporting establishing the JAIN field lab.
  • Explore opportunities related to upcoming 2024 G20 Brazil summit
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